I come by many things in my life naturally - my stubbornness, my red hair and my career. I am very fortunate. Unlike many, I am the daughter of a female emergency physician. This is something I never really considered while growing up. Yes, my mom was a doctor. Did she save lives? I guess so. She didn't spend much time talking about life outside of the home and she was still present for many holidays, birthdays, etc. All I knew was that someday I too would be a doctor. When I refused to set foot in the ED (where she worked and I had visited many times), she simply brought the supplies home to repair my lacerated chin. When I had a fever and abdominal pain, I recall the look in her eyes when she recognized my appendicitis. But, that was life in our home. She did not bat an eye when we injured ourselves because she'd seen worse.

After attending an all-female high school, she went on to join the first class at Loyola College of Maryland (now Loyola University) to allow women, attended University of Maryland for medical school and ultimately became board certified in Emergency Medicine (which was not an available residency when she trained).

Promising health studies often don't pan out in reality. The reasons are many. Research participants are usually different from general patients; their treatment doesn't match real-world practice; researchers can devote resources not available in most physician offices. Moreover, most studies, even the gold standard of randomized controlled trials, focus squarely on causality. They are set up to see if a treatment will work in optimal conditions, what scientists call efficacy. They're "explanatory."

"Sorry, I'm running late ... sorry, to keep you waiting." How many times a day do I say that? Sometimes it is every time I walk into a patient's room as if it is a normal greeting. Sometimes patients respond with: "Oh, you aren't late" or "I haven't been waiting long." I can be so obsessed with not being late that I don't realize I'm actually running on time! But I know it is a common complaint that patients "always" have to wait to be seen by their doctor. One of my senior partners at work used to say "waiting for a good doctor is like waiting to be seated at a good restaurant, it is worth the wait," and never worried about time. I admired how thorough he was with his patients - I don't think any of his patients felt rushed or not heard and came to expect waiting for his care.

Come join me for a day and see for yourself why medicine rarely runs on time...

Envision a large, loafy muffin top. Not just a central bulge or even love handles. I'm speaking of an apron of skin and fat that hangs down over many an American's lower torso and groin. Surely you've seen it - you may even have one. Its medical name is the pannus. I had never heard of a pannus in medical school and I still never hear it mentioned outside of the pathology laboratory. In fact, this article is inspired by conversations I've had with friends who know about medicine and who were nevertheless shocked to hear about the pannus.

Why can I get a comprehensive estimate for something like a car repair, but not a hip transplant?

While a cost range or estimate can be provided regarding what the physician will bill for a specific service, we can - at best - make an educated guess about other surgery costs (hospital bill? anesthesiologist's bill?) and follow-up costs (physical therapy? prescription drugs?). People, unlike cars, are not identical "under the hood," and treatment does not work consistently between people or even at different times for the same person. An expected procedure may need to be changed and additional testing or procedures may be necessary.

This can be a good time to discuss value transparency. Because, like so many things in life, what can look like a "good deal" at the start can end up costing a patient more later on.

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a candidate toward the head of the line? Age? Medical diagnoses? Insurance coverage? Employment status? Worth to society? Criminal record?

Consider the following 6 hypothetical examples of patients who need a liver transplant to survive. How would you rank them? Would those toward the bottom of your list agree with your determination?

Chris Nyte, DO, a former nose guard, reminds us of the horrors of chronic traumatic encephalopathy (CTE) in a May 4, 2018KevinMDpost. Clinical findings associated with CTE include memory loss, depression, anxiety, violent behavior, mood disorders and heightened suicidality, the author informs us. It tends to progress with time and can lead to dementia according to a recent study. And the fact that CTE is a direct result of blows to the head such as those suffered by athletes competing in contact sports, especially football, is no longer in doubt.